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Punctal Occlusion

Clinical Resources

Free and printable clinical forms are offered on this page. Developed by practicing ODs, the forms are designed for use in your practice and include forms for patient consent, patient questionnaires, medical history and billing guidelines.

SPEED II Questionnaire (PDF)

Dry Eye/Allergy (PDF)
Dr. Douglas R. Devries, OD

Informed Consent for Punctal Occlusion (PDF)
Dr. Douglas R. Devries, OD

Patient Billing/Cost Consent Form (PDF)
Dr. Douglas R. Devries, OD

Ocular Surface Questionnaire (PDF)
Dr. Paul Karpecki, OD

How to Use Your Eyedrops (PDF)
Dr. Douglas R. Devries, OD

Eyelid Maintenance (PDF)
Dr. Douglas R. Devries, OD

Billing Guidelines
   Billing Guidelines (PDF)


Wall Chart
   Wall Chart (PDF)

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